AB1097 FEATURES OF THE COURSE AND CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH RHEUMATOID ARTHRITIS WHO UNDERWENT COVID-19
Authors: E. Aronova, G. Gridneva, B. Belov
Journal: Annals of the Rheumatic Diseases (2022)

Background COVID-19 remains a serious problem almost two years later, despite the ongoing active search for effective tools to control it. To date, it is known that COVID-19 not only proceeds as an acute respiratory illness, but also leads to a systemic inflammatory response and hypercoagulability through activation of both the innate and adaptive immune systems. Patients with rheumatic and musculoskeletal diseases appear to be more vulnerable to the development of severe forms of COVID-19 due to the impaired immune response associated with RMD. In addition, immunosuppressants prescribed to control RMD increase the risk of infections. And finally, RMD is often combined with comorbid conditions from the group of risk factors for severe forms of COVID-19 such as arterial hypertension, diabetes mellitus and obesity. Objectives to characterize the features of the course of COVID-19 in patients with rheumatoid arthritis. Methods We studied the material of questionnaires filled out by patients of the hospital of the V.A. Nasonova Research Institute of Rheumatology who underwent COVID-19, verified by RT-PCR to SARS-CoV-2 RNA, for the period from 05/15/2020 to 12/15/2021. The information was supplemented with data from discharge reports after inpatient treatment of COVID-19. Statistica software (version 12) was used for statistical processing. The results of the correlation analysis were considered reliable at p≤0.05. Results The study included 32 adult (over 18 years old) patients (29 women, 90%) with a reliable diagnosis of rheumatoid arthritis (ACR / EULAR). The average age of patients is 50.75 ± 16.48 years. In the study group, 29 (90.6%) patients never smoked, 2 smoked in the past and 1 was an active smoker. The duration of the course of RA (median) was 8 [4; 14.5] years. The most common comorbidities were diseases of the cardiovascular system (in 20 patients), diseases of the gastrointestinal tract (in 7 patients), diabetes (in 4 patients) and obesity (in 5 patients). The median number of comorbid diseases was 1 [0; 3]. At the time of the development of COVID-19, the severity of RA symptoms, assessed by the VAS, was 4.78 ± 3.06. As antirheumatic therapy, 10 (31.25%) patients took glucocorticoids at an average dose of 5 ± 3.9 mg / day. (prednisolone equivalent), 22 (68.75%) - DMARDs. 19 patients received bDMARDs, incl. 12 - rituximab (37.5%, of which 7 received the last infusion within 6 months or less before the first symptoms of COVID-19 appeared). Among the clinical manifestations of COVID-19, weakness was most often noted, fatigue - in 29 (90.6%), fever - in 23 (71.9%), anosmia - in 20 (62.5%), dysgeusia - in 19 (59.4%), increased arthralgia - in 17 (53.1%), shortness of breath during exercise - in 16 (50%), cough - in 15 (46.9%). There was a significant positive correlation between increased arthralgia during COVID-19 and RA activity. On average (median), each patient reported 13.5 [9.75; 19.25] symptoms associated with COVID-19. There was no significant correlation between the number of COVID-19 symptoms and RA activity. During COVID-19, CT scan was performed in 19 patients: CT-0 - in 1 patient (5.3%), CT-1 - in 9 (47.4%), CT-2 - in 5 (26.3%), CT-3 - in 3 (15.7%), CT-4 - in 1 (5.3%). There was no correlation between the CT stage and RA activity. 12 patients (37.5%) were hospitalized, of which 8 needed oxygen support. Rituximab treatment was not associated with hospitalization rates. Complications were reported in 4 cases (12.5%): venous thrombosis in 2 patients and acute respiratory failure in 2 more patients. Conclusion 37.5% of COVID-19 patients in the study group required inpatient treatment. In 12.5% ​​- COVID-19 proceeded with complications. The number of symptoms associated with COVID-19 did not correlate with RA activity. However, patients with higher RA activity more often noted increased arthralgia. Disclosure of Interests None declared